According to my family's recollection, none of our relatives has died fighting for the United States. My grandmother was from a small town in what is now Belarus and most people in the family were born, lived, and died there. One of her brothers, though, did something remarkable. If family memories are correct, he left town and went to the Sorbonne in Paris. After being there a short while, the Great War broke out, and he joined the French army to fight for his new home. He was killed, and my father and two of his cousins are named for him (in an Anglicized way).
I am in the first generation of men in my family to have been able to choose not to go to war. My father was in Korea as a doctor. His father joined the army shortly after immigrating to U.S., but the Great War ended shortly thereafter. My one American-born grandfather tried to join the army for World War I but was too skinny, so he went home and gorged on bananas until he was heavy enough to get in the army. He used to sing me WW I drinking songs when I was a kid. He was very patriotic, and tried to join up again for WW II but was rejected for being too old. He's lucky he was, or my grandmother might have killed him herself. She seemed to understand something my very patriotic grandfather did not---war is dangerous. Even those who survive are often wounded in ways that is not easy to see.
When I was a medical resident I had my own patients at the V.A. hospital. I had vets from WW II, Korea, Viet Nam, and all the times in between. Many of the Viet Nam vets would come to me with the same story: they had headaches, or nightmares, or depression, and had never really talked about it. I would ask them frankly if they thought they had PTSD, and usually they would say they did. Some did very well, some did not. I would always ask them what the did in the war, expecting "infantry" or "marines" etc, but more often than not the answer I got was, "some really bad shit, Doc."
Around that same time I used to stop at a watchmaker's shop down the street from my apartment. The watchmaker was a veteran of the war in the Pacific, where he was a Marine officer. He was wounded several times, spoke of the war often, and had scrapbooks about the war and his buddies. But what he would mention most often was the men he'd killed. He didn't regret it as such, but the memories of killing seemed to haunt him. He would tell me over and over how they'd had to kill or be killed, how they'd had to kill to win the war, to keep their country safe. It was all true. I'm not sure how much it mattered.
As we try to absorb back into society the veterans our latest wars have created, we are facing new and old challenges. Many have the same invisible wounds, but many have additional problems. Traumatic brain injuries and amputations have been very common in the last fifteen years or so due largely to IEDs. And soldiers, sailors, and marines are serving multiple tours year after year, increasing the risk of PTSD and other injuries.
Just as we cannot forget those who have fallen, we must not forget those who have gotten up again, but slowly. Many of them will fall again and again during their civilian lives and we must be prepared to pick them up. It is the very least we can do. The bare minimum, actually.
PTSD is something that I have thought a lot about. I have never had to go to war, I was too young for Vietnam. I do have PTSD from being abused by my older siblings. I see PTSD as an adaptive and ânormalâ response to being forced to live under continuous traumatic stress as in a war-zone. I think it is a normal human response to an intolerable situation, and that anyone and everyone will develop PTSD if they are subjected to sufficient traumatic stress. Being tortured, bullied or being forced to torture or bully others is (I think) the worst, worse than any physical injury. It damages your humanity, your ability to be and recognize others as human beings and the compulsion to treat them humanely.
All the symptoms do make sense to facilitate the survival of the organism, hypervigilance, insomnia, hair-trigger temper, constricted affect, dissociation and the ability to dehumanize others so they can be hurt or killed.
I see PTSD as being due to ânormalâ neurodevelopment while living in a war zone and hurting people. The only way to âfixâ it is by doing the opposite, go through the opposite of living in a war zone and hurting people; that would be living in a low-stress peaceful place and by helping and nurturing people.
PTSD is a consequence of normal neurodevelopmental pathways rewiring the brain to adapt to a war-zone. Recovery from PTSD is going to take normal neurodevelopmental to re-rewire the brain to adapt to peace. I think playing with and nurturing children would be very therapeutic if it can be done safely and under conditions of low stress.
And yes, nitric oxide does facilitate that rewiring. Increasing my NO level did more for my PTSD than 20+ years of therapy with senior clinicians and 20+ years of psychopharm.
@daedalus -- Cannabis has helped mine. I'm still a bit jumpy about touch, but I'm getting better.
Getting back to veterans here, something you don't mention is suicide. The rates of military suicides have been skyrocketing, due largely in part to the military culture that sees depression and other psychological symptoms as weaknesses, not warning symptoms. Every time I read a story about a suicidal soldier or veteran being mocked and blown off by superiors, military physicians, and comrades, it breaks my heart.
We owe it both to those who came back damaged and those who are still serving to create a far more robust suicide prevention system for our country's warriors, beginning within the military itself.
Cannabis helped mine too. It helped me get over the constricted affect. People said I was "more normal" when I was high. That experience helped me to be "more normal" when I was straight. But I don't think it was just the drug, but the group of people I was high with, and the fun things we did during that time.
We also need to be concerned about the families of veterans. SOFAR (Strategic Outreach to Families of All Reservists) deals with this issue. There are chapters in four states [MA. MI,FL, and NY. You can find their website by googling SOFAR.
SOFAR Michigan: 1-877-54 SOFAR
There are so many who don't get the help they need when they come home, it hurts my heart. I was visiting a friend at the VA about a month ago and noticed there was a once a week "support group" for anxiety. I asked if he had attended it and he said, "Yeah, it's just some lady up there telling us to breathe and shit. It was stupid. She doesn't know what I saw."
Thanks for the post. My brother is a Afghanistan and Iraq veteran, still working to fully integrate back into society. He constantly talks of joining back up...partly for the job security and possibility of a promotion to Major, partly to avoid a horrid job market that has not treated him well. He keeps his head up and won't accept help..."others need it more than [him]". But I worry about my baby brother - and all our vets, especially those who don't have traumatic injuries, yet constantly struggle to not fall through the cracks.
Dr O, my suggestion would be for you to try and get your brother to volunteer at doing something, even if he can't find work.
Volunteer work might be more "therapeutic" than paid work because the mindset of "giving back" should be therapeutic also. I think volunteer work with infants or children would be the most therapeutic of all. Something like work helping anyone who recognizes that they are being helped and shows appreciation for that help.
k8 -- my grandpa, when he came back from WWII, was in a deep depression. It wasn't until he met my grandma that he started to improve. Or rather, until he met my grandma's father. Great-grampa Carlson, who died before I was born, served in WWI, on many of the same battlefields that my grandpa fought on. First date with my grandma ended up being the two war veterans pulling out maps and sharing stories.
I can see where it would be not only unhelpful but downright insulting to have some civilian trying to ease the anxiety of a war veteran. What has been seen cannot be unseen, nor understood by those who have not seen it. I have not seen it, and for that I am profoundly grateful, for I have looked into the eyes who have seen.
The D-Day anniversary is just around the corner. My grandpa's eyes get very dark this time of year, though really, it was only the beginning of the horrors he would see. Driving over a landmine, which took out the right side of the Jeep and his buddy riding shotgun. Having blades on the hood of the Jeep to cut the piano wire strung across roads to decapitate soldiers. The Bulge. A bitter lesson in why smoking is dangerous, as he saw a German soldier light up in the night, allowing him to pick the guy off. Teaching all of his hard-earned lessons to newbies, only to watch them ignore it all, thinking they knew better. Liberating guns from those who didn't need them anymore. Liberating Dachau. It was a tough experience for a 19 year old Swedish kid from small-town Minnesota. I can't imagine it's any better for the troops in Iraq and Afghanistan at the moment, and I just pray we don't end up with a third front if the situation in Korea goes pear-shaped.